Malaria: how to use stand-by?

tapir

Hi
I plan not to take preventive malaria pills, but rely on stand-by therapy. I think Malarone is best for this purpose, perhaps Doxycycline.

Yet, I could find only very little about the stand-by therapy. Only the symptoms and that you should visit a doctor as soon as possible.

So, can anyone tell me how you go about the stand-by? Do you take pills immediately when you notice any symptoms? Does one have to carry on taking pills until you see a doctor, or is the therapy "finished" after some days?

tapir

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-m2-

We discussed another promising malaria treatment in this thread which might be of interest. The thread is quite lengthy, this link is to page 3 where the discussion of the chinese herbal cure, artimisinin, begins:

Did you get malaria pill side effects?

chappal

I wanted to start a thread on this, searched, and found this one. I think this merits its own thread because the other ones get involved in more general discussions about malaria. Can we have some discussion just for the information of those who have decided on just carrying a stand-by treatment?

If I find myself with Malaria symptoms, what should I do besides get to a doctor ASAP? Suppose I am a day away from a doctor... what medicine would I want to consider taking immediately?

Suppose I do not have any malaria symptoms, but I was bitten by a mosquito. Any preventative medicines of use at that point? Any treatment medicines to take though there are no symptoms (yet)?

chappal

The posts which M2 linked discusses the growing popularity of the drug Artemisinin. Artemisinin is extracted from the leaves of the Chinese herb Artemsisia annua (qinghaosu or sweet wormwood).

Benefits: no significant side-effects, quickly reduces fever, rapidly lowers blood-parasite levels

Drawbacks: more expensive than some more popular medicines, not widely available (in part because it can't be patented), no US company has registered artemisinin or sought FDA approval

From http://www.drlam.com/A3R_brief_in_do...emisinin.cfm#1 :
"However, the treatment using this herb to treat malaria is not approved for use in the U.S.A due to the concern that it has a 21 percent recrudescent rate. Scientists believe that this is more likely due to patients not taking the compound for a long period. Many of them actually stop taking it as soon as their symptoms subside."

The posts which M2 linked discuss how it is increasingly being accepted by many international organizations and governments. It has had some success against strains of malaria which have adapted resistance to other drugs.

To decrease the development of resistance, artemisinin is given as part of a cocktail of other drugs. A cocktail of artemisinin and lumefantrine (Benflumetol) is sold as Coartem and Riamet.

My inferrence from all of this is that this drug is only used if you have symptoms, not for prevention. Likewise, I have not heard anyone recommending it for last-minute "prevention" -- i.e., after being bit by a mosquito, but not yet any symptoms.

Has anyone here taken a "cocktail" with Artemisinin?

Nick-H

My reaction to taking malarial therapy just because of a mosquito bite is that it is way over the top. Am I wrong? or does it depend on where you are?

I've had lots of mosquito bites, I've never been to India without being bitten at least a few times, but I don't have malaria.

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goangoangone

For treatment I believe you must use a different drug from the one you're taking for prevention. Here are some FAQs
http://www.cdc.gov/malaria/faq.htm

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Kingfisher

If you are not in a malarial area, don't get too excited about an occasional bite. The time to be concerned is if you begin to get feverish -- this could be many things, of course, so the drill is to get to a clinic for a blood test which will give you the answer.

I read an article in a Goa newspaper last week reporting on a recently completed long-term study in Goa testing the efficacy of different malarial drugs in curing the vivax and, the more serious, falciparam variety -- the two strains require different medications and unfortunately I wasn't able to keep a copy of the article and don't want to guess as to the correct medication for each, but they were common names that I've heard mentioned.....the results have been published and should be fairly common knowledge in the medical community. The Artemisin cocktail probably wasn't included in the study. A recent BBC story mentioned that efforts to ramp up production of this drug is going slowly due to the length of time to grow and process the plant -- it is critically needed in Africa. The story mentioned that, as an example Angola had 2m or 20% of the population getting malaria annualy and a horrendous number of deaths of children,

Incidentally, (and from memory only) the Goa article mentioned that malaria became a problem in the state in the mid 90's when great numbers of out-of-state workers arrived, primarily for the building of the Konkan Railroad. Living in squatter camps and around construction areas with pools of stagnant water, malaria began to be noticed even spreading to Panjim and Margao in the wet season. Particularly over the past 5 or so years great effort has been gone into to eliminate the problem -- from establishing larvae-eating fish into ponds, screening of septic tank vents, and the testing and isolating of malarial sufferers to make sure that they do not become vectors for a new outbreak. Malaria is virtually eliminated now, and represents a reasonably minor risk here, particularly in the winter season -- as well, the symptoms are well understood, testing and proper treatment readily available.

As far as the risk in other states, or at other times of the year, I don't know. For myself, I only take anti-malarials if I feel there is a clear need for them but I'd agree that this is a difficult assessment to make and travellers have to make a decision that they are comfortable with for themself. I haven't found any of this Riamet, myself, but if I do come across it, I will add it to my first aid kit along with the meds for Giardia and round-worm (both of which might not show up until one gets home, and which I can diagnose quicker than a western family doctor who knows squat about tropical medical problems and even stool tests can miss)

Incidentally, I notice that a half dozen malaria threads have been activated today. I won't be reading or responding to them as I hate repeating myself and this malaria-mania is really getting tiresome.

cheers!

chappal

Probably so, but then people take preventative medicines when they haven't even been bitten yet! I was just wondering if there was a sort of treatment which is more effective when taken before malaria has had time to incubate, and harmless enough to be worthwhile. Not exactly a preventative medicine, but not a treatment with serious side-effects either.
My understanding of artemisinin is that it is a treatment to be taken once you have been diagnosed with malaria, not for prevention or during potential incubation. Maybe this is just because it is too expensive to bother taking sooner?

Nick-H

that sounds like the Holy Grail of treatments! Just what everyone wants, and just what the pharmaceutical companies would be dead chuffed to come up with

Lets hope!

edwardseco

I'll just add a note that the symptoms vary and may be similar to other serious diseases. I would be very cautious about not consulting a doctor under that condition..

chappal

LOL. I guess I am hoping for too much!

Edwardseco, I agree it is important to see a doctor if there are any symptoms.